Dr. DeLoughry directed wellness programs at a large HMO and served on the medical school faculty at the University of Buffalo. Yet, when his mother was admitted to a nursing home he knew little about the special problems of the elderly.

For this project he collaborated with his wife, Kathy, a stress-management trainer. They drew on their own experiences as caregivers and a successful wellness series they had previously authored. Care guidelines from the federal Centers for Medicare and Medicaid and other sources were researched. "The poem outlines what we wish we knew before our mothers were admitted to nursing homes," says Kathy.

Remember goals: Hopes and dreams are the most powerful motivator we have. Reminding an elder about an upcoming family wedding is more likely to motivate them to eat well, than telling them "it's good for your heart."

Check the signs: The Guide outlines warning signs for most elder health problems. Little problems can quickly become big problems if not caught quickly. Pay attention to the mind, body and the spirit. Each area can influence the others, for good or for bad.

Take some steps: "The satisfaction skills (awareness, affirmations, assertiveness and acceptance) improve communication and reduce stress," says Kathy. Eating well, exercise and the proper use of medications are also crucial.

Learn each time: Will a particular treatment work? "Even the most skilled physician may not be sure," says Dr. DeLoughry. To learn what works, caregivers need to continually recheck health signs and communicate with the care team.

"Caregivers, elders and staff all belong on the quality improvement team. The worksheets and forms in the Guide help them follow the poem toward better health," he concludes.